| アブストラクト | OBJECTIVES: A volume-outcome relationship in ICU patients has been suggested in recent studies. However, it is unclear whether the ICU-to-hospital bed ratio affects the volume-outcome relationship. The aim of this study is to investigate the relationship between hospital volume and in-hospital mortality of adult ICU patients in relation to the ratio of ICU beds to regular hospital beds. DESIGN: Retrospective cohort study. SETTING: Four hundred seventy-seven Japanese hospitals from 2007 to 2012 in the Japanese Diagnosis Procedure Combination database. PATIENTS: A total of 596,143 patients discharged from acute care hospitals. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We analyzed data from 596,143 ICU patients from 2007 through 2012 using a nationwide administrative database. Patients were categorized into nine subgroups (the tertiles of hospital volume of ICU patients combined with the tertiles of ICU-to-hospital bed ratio). Multivariable logistic regression analyses were performed to examine the concurrent effects of hospital volume of ICU patients and ICU-to-hospital bed ratio on in-hospital mortality, with adjustment for patient and hospital characteristics. Higher hospital volume of ICU patients and a higher ICU-to-hospital bed ratio were independently associated with lower mortality. When patients were stratified by ICU-to-hospital bed ratio categories, in-hospital mortality was significantly lower in the high-volume subgroup (odds ratio, 0.74; 95% CI, 0.58-0.93) compared with the low-volume subgroup in hospitals with a high ICU-to-hospital bed ratio. However, these relationships were not significant in hospitals with low ICU-to-hospital bed ratios (odds ratio, 0.94; 95% CI, 0.59-1.50) or in hospitals with intermediate ICU-to-hospital bed ratios (odds ratio, 0.80; 95% CI, 0.71-1.08). CONCLUSIONS: An inverse relationship between hospital volume of ICU patients and mortality was seen only when the ICU-to-hospital bed ratio was sufficiently high. Regionalization and increasing the number of ICU beds in referral centers may improve patient outcomes. |
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| ジャーナル名 | Critical care medicine |
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| Pubmed追加日 | 2015/3/11 |
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| 投稿者 | Sasabuchi, Yusuke; Yasunaga, Hideo; Matsui, Hiroki; Lefor, Alan K; Horiguchi, Hiromasa; Fushimi, Kiyohide; Sanui, Masamitsu |
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| 組織名 | 1Department of Clinical Epidemiology and Health Economics, School of Public;Health, The University of Tokyo, Tokyo, Japan. 2Department of Anesthesiology and;Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama,;Japan. 3Department of Surgery, Jichi Medical University, Tochigi, Japan.;4Department of Clinical Data Management and Research, Clinical Research Center,;National Hospital Organization Headquarters, Tokyo, Japan. 5Department of Health;Policy and Informatics, Tokyo Medical and Dental University Graduate School of;Medicine, Tokyo, Japan. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/25756414/ |
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